HIV care cascade in Albania: analysis of newly diagnosed cases in 2016

Introduction
Despite the fact that there has been a steady rise in new infections rate since the first reported case in 1993, Albania remains a low prevalence country. This was the first cascade study for Albania. The aim was to construct a cascade of care for newly human immunodeficiency virus (HIV)-diagnosed individuals in 2016 in Albania.

Material and methods
This retrospective descriptive study was conducted at the HIV/AIDS Ambulatory Clinic, Infectious Disease Service, University Hospital Centre of Tirana. Medical records of patients diagnosed and enrolled in care in 2016 were retrospectively screened and data on gender, age, HIV clinical stage, CD4+ T cell count, viral load measurement, and treatment history, with antiretroviral treatment (ART) and adherence to treatment were collected.

Results
Out of 127 new HIV cases reported, 100 (78.7%) entered care. The median age was 39 years (range, 20-75 years; male, 82%). Seventy one percent started ART within a median of 56 days (range, 1-317 days) from diagnosis, 34 (47.9%) patients received tenofovir disoproxil fumarate/emtricitabine + efavirenz (EFV), and 27 (38%) zidovudine + lamivudine + EFV. Among those who started ART, 19.7% were late presenters and 54.9% were very late presenters. Viral load after initiation of ART was assessed in 25 cases, with 56% of patients achieving an undetectable HIV-RNA.

Conclusions
A large proportion of people living with HIV were lost at each step of the cascade. Efforts in Albania should be focused on scaling up HIV testing, promoting adherence to ART, improving access to diagnostics, and better ART regimens as well as proper monitoring of therapy.